The Department of Health has published a dear colleague letter addressed to primary care trusts addressing health actions arising out of an analysis of 120 Prisons and Probation Ombusman (PPO) investigations. PCTs are reminded that a death in custody is a Significant Untoward Incident and that the PPO investigator should ask the relevant PCT to facilitate a review of the clinical care received. The clinical reviewer must be a registered healthcare professional, and selection of the reviewer is the PCT’s responsibility. The review should be undertaken in line with NHS polices and guidelines for adverse incidents and forms part of the final PPO report.

The letter advises PCTs that:

• all Department of Health and NHS policies are applicable to prisons, and their healthcare centres. The PPO reviews highlighted that there is currently little evidence of the application of the Care Programme Approach for prisoners with serious mental illness. A series of deaths from natural causes highlight the need for chronic disease management. In addition, substance misusers must be identified, treated and monitored effectively, particularly in the first 72 hours;

• an appropriately skilled and experienced workforce must be in place;

• PCTs should include the prison setting in policy implementation, modernisation programmes and performance monitoring;

• continuity of care, the transfer of clinical information between prisons and record keeping must all be improved and individual poor performance should be addressed. The new prison performance indicators will provide a framework for performance review and may highlight areas where additional intervention can identify steps required to improve care; and

• an integrated approach to the care of people in prison should be promoted and all deaths in custody must be reported as serious untoward incidents.

The circular concludes by stating that it may be helpful for the final clinical review of death in custody, and its action plan to be an agenda for the Prison PCT partnership board, so that it can be discussed and reviewed.

The full text of the letter can be found at: